“Conversion” by Egon Schiele, 1912.

By LAURIE HAAPANEN

A wave of opioid drug use and related deaths has hit the U.S. in the past several years. The state of Maine has been impacted especially hard, most notably in 2016, when opioid-related deaths peaked at 376. In subsequent years, the numbers remained bleak: 2017=360, 2018=202, and 2019= 318*.   In October 2020, the Maine Attorney General’s office published new figures for this year. In total, 258 Maine people have died from drug overdoses through the first six months of 2020, representing a 27% increase over the last two quarters of 2019. The coronavirus pandemic and related economic stresses such as homelessness, job loss, and lack of health insurance, as well as lack of accessibility to recovery services, have been suggested as causes of this increase in drug-related deaths.

Governor Janet Mills (D) announced a new program, the OPTIONS (Overdose Prevention Through Intensive Outreach, Naloxone and Safety) initiative. Under this initiative, mobile response teams will have contact with communities in every part of the state that have high rates of drug overdoses to promote drug prevention and harm reduction strategies, connect people directly to recovery services and treatment, and distribute naloxone, the lifesaving overdose drug also known as Narcan. The OPTIONS teams will focus on populations with high risk of overdose, such as those experiencing homelessness and those recently released from incarceration.

The same week that the OPTIONS program was announced, CNN Business reported on the recent case against Purdue Pharma, the maker of OxyContin.  The company pled guilty to three federal criminal charges for its role in creating the nation’s opioid crisis. The drug was widely prescribed by physicians for pain management when it was first introduced to the market in the 1990s. Purdue Pharma touted it as a miracle drug without disclosing the side effect of severe addiction.

Because the company filed bankruptcy in 2019, it does not have the $8.3 billion settlement amount available in cash, and it will be dissolved as part of the settlement. The case is not without controversy, however, and 25 state attorneys general (including Maine’s) sent a letter to U.S. Attorney General William Barr arguing that the settlement, which includes a government-controlled company created from the assets of Purdue Pharma to oversee the use of the drug for “legitimate” purposes, is flawed because the government should not be in the business of selling OxyContin.

“We believe that Purdue’s assets should be sold to new owners in the private sector. The role of government in any OxyContin business should be to enforce the law, just as against any other company. The public deserves assurance that no opioid business is given the special protection of being placed under a public umbrella. Although it may take time to find a private sector buyer, the public should be confident that public officials are seeking to avoid having special ties to an opioid company, conflicts of interest, or mixed motives in an industry that caused a national crisis.”** There are other lawsuits pending against Purdue from grieving families who blame the drug manufacturer for pushing Oxycontin as a miracle drug.

The U.S. government’s response to the opioid crisis is as inadequate as the response to the current coronavirus pandemic. Although the OPTIONS program and the $8.3 billion settlement against Purdue Pharma are not without merit, it is too little too late. But there are no easy answers. Just throwing money at this type of societal problem is never going to fix it. The root causes of addiction, a very complex disorder, as well as lack of access to effective treatments, is never adequately addressed. 

A Maine family’s story

Socialist Resurgence interviewed Ann Bennett-Cookson, a Maine resident and author of “Secrets, A Story of Addiction, Grief and Healing,” a book about her daughter who lost her life to a fentanyl-laced heroin overdose on Dec. 16, 2016. That was the year with the highest ever number of overdoses, over a death per day. Her daughter was the 374th case out of 376 recorded that year.**

SR: When was the first time you realized that your daughter had an opioid addiction?

Ann: About four years before her death, her boyfriend approached me one night in a very troubling way. He said, “I need to talk to you privately,” and we went into another room of our house. He informed me that my daughter had a drug addiction, but he did not go into any details about what type of drugs.  She wasn’t living with me at the time, so I didn’t see her daily. I did not know what to do. I was in denial for a long time. But then the year she died, she had moved back in with us again, and her boyfriend at that time died of an overdose in our driveway. That’s when I became active in trying to figure out treatment for her, searching for services. She was seeking natural alternatives to medication therapy, whereas I looked for traditional methods.

SR: Was your daughter ever hospitalized?

Ann: No, she did overdose once two weeks before her death, was treated and released from the hospital. But she had no insurance, so she tried to self detox, which is a common problem with addicted people without insurance. It was rugged because I found her the afternoon she died.

SR: Do you see any solutions to the obstacles that people with addiction face?

Ann: Besides the lack of insurance, the stigma is terrible. Addicted people are viewed as morally bankrupt or criminal. My daughter received death threats from the drug underworld. The way the establishment (government, legal system, medical facilities) treat people with addiction is unfair. The carceral system is a real problem. When police came to our door they would sound reasonable and supportive at first, then they would threaten to arrest her if she didn’t tell them where she had gotten her drugs. If people had access to medical treatment regardless of insurance, and rehabilitative services, that would be a start. And removing any legal obstacles would help. That’s why harm reduction programs are critical in Maine to take away stigma, judgment, and to build compassion for the addict as well as to provide urgent services such as clean needles and access to Narcan. And training programs to help families dealing with this crisis. We did have Narcan in the house the night my daughter died. The doctor had prescribed it for me to have it available in case, but I didn’t have the presence of mind to ask her or the pharmacist how to use it!

SR: Why did you decide to file a lawsuit against Purdue Pharma?

Ann: Filing the lawsuit allowed me to get more closure and I felt I was adding another voice to countless other voices who expressed the pain and loss directly related to these people’s actions which were founded on greed. I recognized initially that our family would probably never see a cent, but that wasn’t the point. How can you put a price tag on a person’s life? But I wanted to make a point and make some noise. Families like ours need and deserve to be recognized and validated.

The harm reduction movement

Harm reduction is a concept in the therapeutic community that is sometimes used by the providers on the ground—EMTs, medical and mental health personnel. The National Harm Reduction Coalition was formed to address the issues of stigma, recognizing that drug use is “a complex phenomenon that encompasses a continuum of behaviors from severe use to total abstinence and acknowledges that some ways of using drugs are clearly safer than others.”***

Harm reduction finds its roots in various social movements in the U.S. during the ’60s, ’70s, and ’80s—the Black Panthers survival programs such as Free Breakfast for Children and health clinics; the Young Lords’ acupuncture program for heroin users in the South Bronx; and more recently in the women’s reproductive rights movement and AIDS movement in the ’80s. The Harm reduction movement is part of the model for public health that seeks social justice as an underlying principle. Harm Reduction is a progressive step forward.

The use of Naloxone, most commonly known as Narcan, is a lifesaving drug for those experiencing overdoses. There is now an intranasal spray that is easy for a non medical person to administer to someone overdosing. Narcan has been distributed in Maine to users and their families through programs such as the Needlepoint Sanctuary, formerly known as the Church of the Safe Injection (CSI), which was started by Jesse Harvey, a recovering addict who tragically lost his life to an overdose in September.

The City of Portland Office of Public Health has a needle exchange program with a total of 3316 enrollees in 2018.  There is also a Naloxone distribution program as well as trainings in Overdose Recognition and Response and Naloxone provided by the Needle Exchange Program Staff.

There are many people working to stop the opioid crisis on the ground in Maine. At a recent Harm Reduction Conference sponsored by the University of New England, over 400 participants engaged in workshops designed to train people on the use of Narcan, advocacy to improve services for drug users, including advocating for a Supported Injection Facility (SIF)—a very controversial issue. SIFs are designed to provide medically supervised heroin injections. There are no SIF’s in Maine or the rest of the country yet, although Oregon has very recently passed laws: Oregon Measure 110, a law which decriminalizes the possession of small amounts of drugs, including heroin, methamphetamine and LSD. It is a step in the right direction.

Under the current for-profit medical system, however, it is impossible for real change to occur in stemming the tides of opioid-related deaths. Drug addiction is a complex issue, with multiple variables requiring multiple solutions. There has been a panic within the Maine  medical community because of accusations of  overprescribing opioids, and many doctors are reluctant to prescribe any opioids for fear of creating more addiction and  potential  malpractice suits. It is an unfortunate swing of the pendulum in response to the crisis, because people in pain have been turning to heroin and other street drugs to ease their suffering.

It’s a vicious cycle.Big Pharma will continue to exist in many insidious forms even if big lawsuits are successful, such as this latest one against Purdue, and profit margins will continue to increase. Meanwhile, health insurance costs keep rising, and a large portion of people affected by opioid addiction do not have access to health insurance—or if they do, it is woefully inadequate.

The coronavirus pandemic has only exacerbated the crisis. Poor and working-class families who have been affected by opioid addiction will continue to be torn apart by this epidemic, without adequate programs to assist their loved ones. If the American people had access to universal health care, at least access would no longer be a barrier for treatment. It would be a good first step in combating this horrible crisis.

Notes: 

*Data from www.drugabuse.gov opioid summaries by state. What is not clear from this writer’s research is how many non overdose deaths are caused from complications of drug use such as Hepatitis C or HIV which is on the rise.   Although these deaths may  not be  recorded as overdoses per se, they are related to substance use and are not reflected in the overall costs in human lives.

**CNN Business News, Oct. 21, 2020, “OxyContin maker to plead guilty to federal criminal charges, pay $8B and will close the company

***National Harm Reduction Coalition Statement of Principles; see harmreduction.org